Evaporative dry eye (EDE) is one of the most common afflictions of the eye. If you feel your eyelids to be swollen and your eyes feel dry and itchy, tending to worsen in the mornings, then it could very well be that you suffer from Evaporative dry eye or EDE. Evaporative dry eye is caused when the glands of your eyelids become clogged and you start to lack quality tears. The oil glands lining the corners or margins of your eyelids become blocked and cause your tears to dry out. It is quite common and you can, in fact, feel better even at home. This is no doubt an uncomfortable condition to suffer from. Usually, this condition affects older people, but it can happen at any age. People with diabetes or with oily skin are more likely to get this condition. It also affects women more than men.
What is Evaporative Dry Eye Disease?
One of the most common types of conditions afflicting the eyes, evaporative dry eye disease is an uncomfortable disorder of the eyes. The condition happens due to the blockage of the oil glands that line the corners of your eyelids. These oil glands, known as meibomian glands, are responsible for releasing oil that protects and covers the surface of your eye. These glands are also responsible for preventing your tears from drying out.
Tears are what help your eyes from becoming dry. Every time you blink, a little bit of tear fluid comes out from the oil glands at the corners of your eyelids. This fluid helps in washing away dust, germs, and other things that may get into your eye. When these meibomian glands do not work properly, your tears will dry out faster, making your eyes feel dry, itchy, and sore.
Evaporative dry eye or EDE is known to affect the elderly more, but it can occur to anyone at any age. It is more commonly known to affect women rather than men and also those with diabetes or having oily skin conditions.
Causes of Evaporative Dry Eye
Your tears are made up of oil, water, and mucus. Tears are responsible for forming a protective layer over your eye’s surface, making the surface of the eye appear smooth and also protecting your eye from infection. Tears need to be made up of these three things in a particular ratio so that it can help you see clearly. When your meibomian glands become blocked, the ratio of water, oil, and mucus become disturbed. Your tears then stop producing the correct quantity of oil that prevents them from evaporating. This causes Evaporative dry eye or EDE.
There are several factors that can lead to the blocking of your meibomian glands. If you are not blinking frequently, then you might develop a collection of debris at the corners of your eyelids which can block the glands. Concentrating too hard at a computer screen, driving for long distances and concentrating on the roads, and reading too much are all factors that can prevent you from blinking frequently. Some other factors that can cause blocking of the meibomian glands include:
- Wearing contact lenses for a long period of time
- Skin disorders such as psoriasis, face or scalp dermatitis, rosacea, etc.
- Medications such as hormone replacement therapy, antihistamines, antidepressants, retinoids, decongestants, or even diuretics
- Many illnesses such as diabetes, thyroid condition, Sjogren’s syndrome, rheumatoid arthritis, etc.
- Allergies impacting the eyes
- Some environmental toxins
- Eye surgery
- Vitamin A deficiency
- Eye injury
Evaporative dry eye or EDE needs to be treated once identified as timely treatment can reverse the blockages in the meibomian glands. If Evaporative dry eye or EDE becomes chronic, then you will need ongoing treatment of the symptoms.
Symptoms of Evaporative Dry Eye
Symptoms of Evaporative dry eye or EDE tend to vary according to the severity of the disease. Many times you will not feel anything and you will only notice something when your eyelids begin to feel swollen or sore. Evaporative dry eye often makes your eyes feel itchy or gritty as if something is stuck in them. Eyes can also become red, watery, and sore, making it difficult to have a clear vision. Other common symptoms of Evaporative dry eye or EDE include:
- Stinging sensation
- Inability to wear contact lenses
- Sensitivity to light
- Eye fatigue, particularly after reading or working on the computer
- Grittiness as if there is some sand in your eyes
- Crustiness
- Blurry vision that comes and goes
- Increased redness
- Eyelids may appear to be swollen
Diagnosis of Evaporative Dry Eye
If you feel pain in your eyes or some discomfort, or if you notice that your vision is becoming blurry, then you must consult a doctor without delay. Your doctor will ask you about your general health, medications you are taking, and conduct a thorough eye examination. If needed, your general physician will refer you to see an ophthalmologist, who specializes in eye-related conditions.
Some specialized tests are conducted to determine if you are suffering from Evaporative dry eye or EDE. These tests measure the volume of tears and also the quality of your tears. Some of these tests include:
- Dyes are mixed in eye drops to help view the eye’s surface and measure the evaporation rate of tears.
- A slit-lamp, which is a strong source of light, and a low-power microscope, is used by the doctor to look at the eye’s surface.
- The test for measure tea volume is known as the Schirmer test. In this test, strips of blotting paper are put under the lower eyelids to measure how much moisture is being produced after five minutes.
- Other tests may also be conducted to rule out any other causes of your symptoms.
Treatment of Evaporative Dry Eye
Treatment of Evaporative dry eye or EDE is possible and depends on whether or not there is an underlying systemic cause for your symptoms. For example, if a medication is causing Evaporative dry eye then you might be suggested an alternative medication which will provide relief in your EDE symptoms. If a disorder such as Sjogren’s syndrome is suspected, then your doctor will recommend a specialist to you for further treatment.
Even simple changes such as cleaning your contact lenses with a different solution, or using a humidifier to add moisture to the air, or using a warm compress, may provide relief. A warm compress applied to your eyelids twice a day will also help in overcoming moderate blockage of the meibomian glands. An over-the-counter lid scrub for keeping your eyelids clean is also effective. Some doctors even suggest that you use baby shampoo instead of the more expensive lid scrubs.
Eye drops and artificial tears are recommended to keep the surface of your eyes moisturized and to feel comfortable while blinking. There are many eye drops, artificial tears, ointments, and gels that are available today and you might have to experiment with a couple before finding one that suits you the most.
In cases where the blockage of the meibomian glands is severe, other treatment options would include:
- Training and exercises in blinking that help the functioning of the meibomian gland.
- Therapy involving intense pulse light combined with eye massage to provide symptomatic relief.
- Lipi Flow thermal pulsation system, provided only at a doctor’s clinic, helps to unblock the meibomian glands by giving the lower eyelid a pulsating massage for 12 minutes.
- Prescription medications such as a liposomal spray, topical azithromycin, oral tetracycline, or anti-inflammatory drugs.
Home Remedies to Treat Evaporative Dry Eye Or EDE
It is possible to get relief from certain home remedies if you suspect you have Evaporative dry eye or EDE. While trying out any home remedy on your eyes, you have to remember that your eyelids are very delicate and it is important to be gentle while carrying out any remedy. Also, if your symptoms tend to persist, then consulting a doctor will be the best option.
- Massage Your Eyelids: Massaging your eyelids will help to release tears. You can also massage your eyes while having a warm compress on them. Simply press your fingertips gently on to the edges of your eyelids, just above the eyelashes. While you look up, roll your finger upward onto the lower eyelid. Then, roll your finger downward on the upper lid while looking down. Too much pressure will make your eyes feel worse, so be careful while massaging your eyes.
- Applying a Warm Compress: Take a face cloth or cotton pads and soak it in lukewarm water. Now close your eyes and hold the warm cloth above your eyes, onto your eyelids. Keep it on for five minutes and then repeat with the other eye. Doing this twice daily will make your eyes feel better. Once you experience some relief, you can do it only once a day. Applying heat to your eyes helps the glands produce more oil, melts away any crusting in the area that might have formed, and also makes the moisture from the glands flow more freely.
- Clean the Lash Line: Take a Q-tip or a warm washcloth to gently scrub along the eyelash line of both eyelids. This helps to remove any oil, bacteria, or other debris that might be blocking the gland openings. To clean, you can use either baby shampoo (watered down) or any gentle soap, making sure the product does not irritate your eyes. Doing this once a day will provide relief.
- Increase Your Consumption of Omega-3 Fatty Acid: Omega-3 fatty acids are known to improve the quality and consistency of the oil present in your eyes. Fish, flaxseed, walnuts, canola oil, etc., are good sources of omega-3 fatty acids.
What Happens If EDE Is Not Treated?
If left untreated, then the associated pain and discomfort from dry eyes is going to make it difficult for you to carry out your daily activities. It may also lead to some serious complications and also increase your risk of eye infections. These may include blinding infections as well since you are not producing adequate tears to protect the eye’s surface. Eyes may become swollen and you will be at a higher risk of permanently damaging or scratching your cornea.
Prognosis & Outlook for Evaporative Dry Eye
It is possible to successfully treat Evaporative dry eye or EDE. In most mild to moderate cases, an initial round of treatment is enough to clear up the problem. If there is an underlying condition contributing to Evaporative dry eye or, then it is important to treat that condition first, while managing your eye symptoms. If symptoms become chronic, then using artificial tears, medications, and eye drops will make your eyes feel comfortable.
- Nichols, K. K., Foulks, G. N., Bron, A. J., Glasgow, B. J., Dogru, M., Tsubota, K., … & Lemp, M. A. (2011). The international workshop on meibomian gland dysfunction: executive summary. Investigative Ophthalmology & Visual Science, 52(4), 1922-1929.
- Messmer, E. M. (2011). The pathophysiology, diagnosis, and treatment of dry eye disease. Deutsches Ärzteblatt International, 108(40), 690.
- Craig, J. P., Nelson, J. D., Azar, D. T., Belmonte, C., & Bron, A. J. (2017). TFOS DEWS II report executive summary. The Ocular Surface, 15(4), 802-812.
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